“Memo To GOP”: The War Over Big Government Health Care Is Over, And You Lost
The federal government has released new data on Medicaid enrollment showing that with the implementation of the Affordable Care Act, six million Americans were added to the program’s rolls. That’s six million low-income people who now have health coverage, who can see a doctor when they need to and who don’t have to worry about whether an accident or an illness will send them spiraling into utter financial ruin.
The numbers reveal something else, too, something that should horrify conservatives: we’re well on our way to health-care socialism.
Okay, that’s an exaggeration. But only a slight one. And at a time when the press is realizing that Republicans are losing their taste for anti-Obamacare bloviating (more on that in a moment), it shows that Bill Kristol’s nightmare has nearly come true.
Back in 1993, Kristol wrote Republicans an enormously influential memo advising that the best approach to Bill Clinton’s health reform plan was not to do everything they could to kill it outright. If any plan managed to pass, he warned, “it will re-legitimize middle-class dependence for ‘security’ on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.”
Now let’s look at where we are today. Prior to ACA implementation, there were just under 59 million people enrolled in Medicaid and CHIP, the program that covers poor children. States that accepted the ACA’s expansion of Medicaid signed up a total of 5.2 million new people. The states that rejected the expansion signed up an additional 800,000; these are “woodwork” enrollees, people who were already eligible under their state’s (often absurdly restrictive) rules, but came out of the woodwork to sign up because of all the attention to health care. Add them in, and there are now 64 million Americans on Medicaid and CHIP.
On top of that, there are now over 52 million seniors on Medicare. There are another 9 million veterans enrolled in the Veterans Health Service.
That’s a total of 125 million Americans getting their insurance from the federal government (or, in the case of Medicaid, a federal-state program). The current U.S. population is 318 million. That means that 39 percent of us, or just under two out of every five Americans, are recipients of government health insurance.
As a liberal, of course, I believe that’s a good thing, though just how good varies from program to program (I’ve spent enough time fighting with private insurance companies to wish I could be insured by the government). Conservatives, on the other hand, view this as a disaster. What they’ve only partly come to terms with is the fact that it’s going to be almost impossible for them to do anything about it.
It’s true that Republicans appear to have realized that while the ACA remains unpopular, the idea of repealing it is even less popular. Which is why, as the November election approaches, they’ve almost stopped trying to elevate the issue. As Sam Baker points out, Republicans passed on the opportunity to use the confirmation of Sylvia Burwell to be HHS secretary as a forum to relitigate the law, and the bills circulating around the Hill on health care are now more likely to be small-bore fixes. Notes Baker: “Anyone who’s been around Capitol Hill and health care for the past four years can see it — the anti-Obamacare fire just isn’t burning as hot as it used to.”
Beyond that, as this blog has documented, multiple Republican Senate candidates are now mouthing support for Obamacare’s general goals and have essentially been reduced to gibberish when trying to explain their “repeal and replace” stance.
But the story is bigger than all of this. Republicans may have to accept that while we may not have the single-payer system liberals want, government still dominates American health care, and that isn’t going to change.
It isn’t just that Republicans could stage another fifty ACA repeal votes in the House and accomplish just as little as the last 50 repeal votes did. Rather, it’s that even if Republicans took back the White House and both houses of Congress, moving people off their government insurance would be next to impossible.
One of the most important lessons of the last 20 years of health reform is this: people fear change. That’s what the Clinton administration found out when their attempt at reform crashed and burned, in large part because the Clinton plan would have meant a change in coverage for most Americans. The Obama administration took that lesson to heart in creating its plan, which was designed to give coverage to people who lacked it but offer only new protections to those who already had insurance. That was also the reason for the false but endlessly repeated “if you like your insurance, you can keep it” assurances — they knew that if most Americans, particularly those with somewhat-secure employer plans, thought they’d have to endure some kind of change, then they’d once again be gripped by fear.
Any Republican plan to unwind the ACA is going to run headlong into people’s fear of change and be stopped in its tracks. Are you going to push 64 million Medicaid and CHIP recipients off their current insurance and onto private plans? Are you going to move away from employer-provided coverage? Are you going to privatize Medicare?
Perhaps, given the right circumstances, Republicans could overcome that fear. But I wouldn’t bet on them finding a way to do it.
By: Paul Waldman, The Plum Line; The Washington Post, June 5, 2014
“Why So Many Are Clueless”: Shameful Coverage Of Obamacare’s Real Impacts
If you read my column last week about a Senate hearing that showed how Obamacare has affected Americans, you might have wondered if I was in the same room with reporters who presumably covered the event.
The disparity goes a long way toward explaining why so many of us are clueless about the actual impact the law is having on our lives.
The title of the May 21 Senate Commerce Committee hearing: “Delivering Better Health Care Value to Consumers: The First Three Years of the Medical Loss Ratio.” I was one of four witnesses talking about the part of the law that requires health insurers to issue rebates to policyholders if they spend more than 20 percent of premiums on non-medical expenses, including profits — the so-called Medical Loss Ratio.
Prior to the passage of the law, insurance company executives — who consider what they spend on medical care to be a loss — were in many cases devoting up to half of premiums they collected to pay for advertising and other administrative functions and to reward executives and shareholders.
As I wrote last week, consumers have saved at least $3 billion since the provision of the law that mandates insurers must spend at least 80 percent of our premiums on medical care went into effect in 2011.
The hearing wasn’t just about numbers, however. Katherine Fernandez, a small business owner from Houston, testified about how the MLR provision and other aspects of the law have enabled her family to pay less for far more comprehensive coverage than was possible in the past.
She told the committee that because both her husband and son had pre-existing conditions, the only policies available to them pre-Obamacare would not cover any medical care pertaining to those maladies. And even then the policies had both high premiums and high deductibles. She said that during the 14 years prior to the law’s passage, her family paid more than $100,000 in premiums for what she described as bare-bones coverage. And the premiums went up sharply every year — 165 percent between 2000 and 2003 alone.
She said she was elated when the Affordable Care Act passed. “No more pre-existing condition clauses … and insurance companies had to refund some of what we paid if they didn’t spend enough. What reasonable ideas.”
If you read the accounts of the hearing in The Washington Post, USA Today, Politico or CBS News — the only news outlets I could find that provided any coverage — you would not have read anything about the $3 billion consumers have saved as a result of the MLR provision or how the law has benefited the Fernandez family.
The focus of all those stories was a brief exchange toward the end of the hearing between Committee Chair Jay Rockefeller, a West Virginia Democrat, and GOP Sen. Ron Johnson of Wisconsin about whether the color of President Obama’s skin might explain why some people are opposed to the law.
Rockefeller suggested race might be a factor, which provoked a spirited denial from Johnson. Politico’s only hint about the hearing’s actual subject was this: “His (Rockefeller’s) critiques of the GOP again came in a sparsely attended committee hearing, this time during an analysis of health-care spending.”
The only one of these pieces that even mentioned “medical loss ratio” was the CBS story, and it, too, was primarily about the exchange between Rockefeller and Johnson. In the USA Today article, which apparently was based on a National Journal transcript, the only hint of a hearing was in the very last sentence: “Rockefeller then veered into another topic before adjourning the hearing.”
That other topic, of course, was the medical loss ratio.
The Washington Post likewise found medical loss ratio of no interest. Its story, too, was about the back-and-forth between Rockefeller and Johnson during what the reporter dismissed as “an otherwise sleepy committee hearing.”
Granted, it is challenging to substantively cover the Affordable Care Act. The U.S. health care system is dizzyingly complex, and so is the law. It’s far easier to write about constant political sparring than to take the time to educate readers about what’s actually in the law and how it affects people. It’s not a heavy lift to review a transcript and write the kind of “he said, she said” — in this case the “he said, he said” — coverage that passes for journalism.
There are a lot of reasons why Americans don’t know how the law affects them or why they believe things about Obamcare that aren’t true. The Democrats have done a lousy job of explaining it. And more than $400 million has been spent by opponents attacking it — 15 times as much as has been spent by supporters. But one of the biggest reasons is the failure of many in the media to provide anything other than the most superficial coverage. As a former reporter who used to cover hearings on the Hill, I consider that shameful.
By: Wendell Potter, The Center For Public Integrity, June 2, 2014
“Rand Paul’s Crazy Word Salad On Obamacare”: A Symbol Of GOP’s Larger Mess
Sen. Rand Paul made national news this weekend when he refused to say precisely whether he wanted to repeal Kentucky’s version of the Affordable Care Act, Kynect, along with the federal act itself. He bobbed and weaved like his boy Mitch McConnell, and most people have left it at that: another scared Republican afraid to tell the voters what he really thinks about a program that’s helped many of them. Reporters are used to that. Nobody except liberals even criticize it anymore, sadly.
But I want to look at Paul’s entire ludicrous soliloquy on Obamacare, Kynect and healthcare generally, because it shows how fundamentally unserious he is about domestic policy. Or if he is serious, he’s seriously delusional. It was every bit the nonsensical word salad we are used to being served by Sarah Palin, but maybe it’s sexism: Paul is never called out on it or mocked the way the former Alaska governor was. He ought to be.
I’ve written before that “Paul is what you get when traditional and corrosive American nepotism meets the 21st century GOP echo chamber: a pampered princeling whose dumb ideas have never been challenged by reality.” Ron Paul’s son has a tendency to look proud of himself whenever he shows a passing familiarity with facts and figures and ideas, even if he’s conflating or distorting them beyond any resemblance to reality. It’s on display in this interview with Kentucky reporters.
The junior senator from Kentucky starts out by acknowledging that Kynect gets a lot of praise, locally and nationally.
I think the real question that we have in Kentucky is people seem to be very much complimenting our exchange because of the functionality of it, but there are still the unknown questions or what’s going to happen with so many new people.
OK. Let’s take a look at “what’s going to happen with so many new people.” Here Paul rolls out some brand-new GOP anti-ACA scare tactics. First: The rapid expansion of Medicaid, he claims, is costing jobs.
I mean it’s basically about a 50 percent increase in Medicaid in one year. That’s a dramatic shot to a system. And my question is what will happen to local hospitals. If you look at [Glasgow, Kentucky, hospital] TJ Samson laid off 50 people and they’re saying they can’t afford the huge burden of Medicaid.
Oops, stop right there. While the hospital’s CEO did in fact link the layoff of 49 staffers to Obamacare in April, days later the Kentucky Cabinet for Health and Family Services disputed that account. It said the hospital would take in hundreds of thousands of dollars more in Medicaid funding annually, because it’s now being reimbursed for uninsured patients it used to treat without payment. Asked about the discrepancy, Paul just pointed to earlier reporting about the Samson CEO’s remarks and said: “All I know is what I read in the papers.”
So for President Rand Paul, the buck would presumably stop with the papers.
Then Paul raised the specter of folks getting their private health insurance subsidized under the Affordable Care Act, but with such high deductibles that they ultimately won’t be able to pay.
That’s gonna mean … you’re still just a non-payer, probably. And hospitals are going to have to figure out, we won’t know this for six months to a year, how many people who show up with subsidized insurance will actually be able to pay [their] deductible.
This could conceivably be a problem – actually, it was a big problem before the ACA – but Paul has no evidence the ACA made the problem worse. More likely it has helped some, because even with a high deductible plan, many preventive services are now provided without a co-pay. The point is, there’s no evidence of such a problem yet; Paul is just throwing trash at Obamacare to see what will stick. And there’s more:
How many of the new people on Medicaid, how many of those people may have actually had insurance before? Did they go from being a non-payer to being a government payer? Or did they maybe have insurance, but now they’re on Medicaid because it’s easier than having insurance?
Paul could probably find out the answers to these questions, with staff work and a little consultation with the Kentucky Cabinet for Health and Family Services, but he would never bother. After hearing all of this bad news, much of it invented, a local reporter asked the senator the obvious question:
With all those unknowns, do you think Kynect should be dismantled?
And here Paul joins McConnell and punts. Or lies, since it’s pretty sure from his answer he thinks Kynect should be dismantled.
You know I’m not sure — there’s going to be … how we unravel or how we change things. I would rather —I always tell people there’s a fork in the road.
Oh, that fork in the road. Paul turns to boilerplate conservative rhetoric:
We could have gone one of two directions. One was towards more competition and more marketplace and one was toward more government control. The people who think that the government can efficiently distribute medicine need to explain why the VA’s been struggling for decade after decade in a much smaller system.
Points for working in the VA, the Obama scandal du jour. Let’s leave that alone, it’s a story in itself. Continue, Sen. Paul:
And they also need to explain, even though I think we all want Medicare to work better, why Medicare is $35 trillion short.
Huh? First of all, Paul doesn’t “want Medicare to work better,” he wants to repeal it. That’s something you don’t hear much about, but he sponsored a bill with Utah Tea Party Sen. Mike Lee to replace Medicare with the Congressional Health Care Plan members of Congress buy in to, essentially privatizing it. The bill would also raise the age of eligibility from 65 to 70. That ought to go over well with the GOP’s rapidly aging white base. That’s why Paul is forced to lie about his own Medicare position.
And the allegation that Medicare is “$35 trillion short”? I could find no documentation for it besides a Heritage Foundation blog post, and a ton of YouTube videos where Rand Paul makes the claim on Fox News. It seems to refer to a 2011 estimate by Medicare trustees that the Part A Trust Fund would face a shortfall by 2026 unless payroll taxes were raised or program costs were trimmed – and the Affordable Care Act has been trimming them. It’s bunk.
Then Paul turns briefly to the question of Kynect:
There’s a lot of questions that are big questions that are beyond the exchange and the Kynect and things like that. It’s whether or not how we’re going to fund these things.
But then he detours again, to take us back to the already debunked example of TJ Samson hospital’s Medicaid-induced “layoffs.”
If they lose 50 good paying jobs in the hospital, is that good? Then we’ve got more people in the wagon, and less people pulling the wagon.
With that profound Kentucky take on Paul Ryan’s “makers vs. takers” narrative, he walks away. And we’re back to Mitt Romney’s deriding the “47 percent.” In Paul’s more colorful telling, the problem is that some of us pull the wagon, while freeloaders and layabouts just lounge in it. For 50 years, Republicans have tried to tell voters the folks “in the wagon” are minorities. But in Kentucky, which is 88 percent white, they’re mainly white. So Rand Paul, the great 2016 hope, is really a prisoner of the elitist 2012 narrative that cost the GOP the White House.
Even though there’s so much to explore in Paul’s Kynect two-step – delusion, ideology, outright lies – the media mostly ignored it. Those who’ve paid attention simply covered the admittedly newsworthy Obamacare evasion. But I think Paul’s entire stand-up act, his performance art — Being a Very Serious Senator, or at least playing one on TV — deserves more attention. It’s only the soft bigotry of the media’s low expectations for Republicans, and maybe a little of society’s sexism, that makes Rand Paul someone to contend with in 2016, when Sarah Palin is widely just a punch line.
By: Joan Walsh, Editor at Large, Salon, June 2, 2014
“McConnell’s Obamacare Policy”: Repeal It, Then Immediately Reinstate The Whole Damn Thing
I think there’s one way, and only one way, to interpret Mitch McConnell’s position on the Medicaid expansion in Kentucky, and last night the Washington Post’s fact checker confirmed it. McConnell wants to repeal the Medicaid expansion (along with the rest of Obamacare) and then let the people who run the state of Kentucky (i.e. people other than him) decide whether to reinstate it, and pay for it out of state coffers.
That’s a difficult position to support, which explains why his campaign obscures it behind a bunch of rambling designed to convince people (including very politically savvy people) that McConnell has come around to supporting the Medicaid expansion.
But it’s actually identical to his position on Kynect—the state’s health insurance exchange—and perhaps he’ll apply it to other integral parts of Obamacare as well. As a general matter it amounts to arguing that Obamacare should be repealed, and then reinstated in full at the state level. But that’s a total fantasy.
When Obamacare is repealed, the funding Kynect relies upon, as well as the health plans and rules that make it a popular and widely used portal, will disappear as well. No biggie, says McConnell. Once they’re gone, the state can decide whether it wants to reinstitute those things on its own.
But of course, as with Medicaid expansion, it’s almost impossible to imagine states riding to the rescue of those harmed by Obamacare’s repeal. Running the exchange is fairly expensive on its own, but its costs would dwarfed by the resources required to recreate the actual market Obamacare has created in Kentucky. Remember, Kentucky flirted with creating Obamacare’s coverage guarantee without creating any incentives for everyone to purchase insurance. No mandate, no subsidies. And the system predictably collapsed. But it’s unlikely that Kentucky could afford to reinstate ACA-style subsidies on its own. And without them, the plans will be too expensive to justify a mandate. And so under McConnell’s policy, Kentucky’s newly insured would be left with nothing.
The idea that ACA politics are gruesome for Democrats is so deeply ingrained in the national media’s belief system that it won’t be shaken loose by McConnell’s dissembling alone. But if it were true, why would Republicans across the country be hiding their true views about Obamacare behind the word “fix”? Why would any Republicans, let alone the Senate GOP leader, be saying they want to get rid of everything Obamacare does except the things it does in their own states?
By: Brian Beutler, The New Republic, May 30, 2014
“Repurposing Of A Failed Website”: The Republicans’ Subtle Retreat From ‘Obamacare’
House Republicans held a press conference on Capitol Hill this week, at which the New York Times’ Jonathan Weisman tweeted a fascinating image – of the podium.
If you look closely, you’ll notice the sign on the podium not only refers people to a website run by the House Republican Conference, but also to a specific part of the site – gop.gov/yourstory – followed by a tagline that reads in all caps, “Our veterans deserve better.”
At first blush, that wouldn’t seem especially noteworthy, except up until very recently the gop.gov/yourstory website served a very different purpose: it was set up to collect scary stories from people who didn’t like the Affordable Care Act. Republicans launched a months-long campaign to collect anecdotal evidence from “Obamacare victims” and this website was intended to be the go-to destination for those adversely affected by the health care reform law.
But the political winds have changed direction. The crusade to find “Obamacare victims” has run its course – the evidence never materialized – and House Republicans are ready to give up on the campaign and start collecting other horror stories the party can try to exploit for partisan gain.
The repurposing of a failed website is, however, just a piece of a larger puzzle. As Juliet Eilperin and Robert Costa reported this morning, Republicans suddenly find themselves in “retreat” on health care.
Republican candidates have begun to retreat in recent weeks from their all-out assault on the Affordable Care Act in favor of a more piecemeal approach, suggesting they would preserve some aspects of the law while jettisoning others.
The changing tactics signal that the health-care law – while still unpopular with voters overall – may no longer be the lone rallying cry for Republicans seeking to defeat Democrats in this year’s midterm elections…. On the campaign trail, some Republicans and their outside allies have started talking about the health-care law in more nuanced terms than they have in the past.
Imagine that. Running on a platform of taking health care benefits from millions of people isn’t the winning strategy far-right lawmakers thought it’d be.
“The sentiment toward the Affordable Care Act is still strongly negative, but people are saying, ‘Don’t throw the baby out” with the bathwater, Glen Bolger, a partner with the GOP polling firm Public Opinion Strategies, told the Washington Post.
Remember when Republicans assumed they could simply ride a “Repeal Obamacare!” wave to electoral fortunes? That plan has been thrown out the window.
And what about the House GOP’s vaunted alternative, years in the making?
[S]enior House Republicans have decided to postpone a floor vote on their own health-reform proposal – making it less likely that a GOP alternative will be on offer before the November elections, according to lawmakers familiar with the deliberations. The delay will give them more time to work on the bill and weigh the consequences of putting a detailed policy before the voters in the fall, lawmakers said.
I suspect this isn’t more widely considered a humiliating fiasco for Republicans because most political observers simply assumed they’d fail to present their own plan, but this new “postponement” only makes the GOP’s debacle look worse.
Remember, it was exactly four months ago today that House Majority Leader Eric Cantor (R-VA.) publicly vowed, “This year, we will rally around an alternative to Obamacare and pass it on the floor of the House.”
That was Jan. 30. On May 30, Cantor’s new message is apparently, “Check back after the elections.”
Americans have only been waiting five years for the Republican alternative to the Affordable Care Act. What’s another seven months?
We know, of course, why GOP officials are struggling. As we talked about in February, Republicans could present an alternative policy that they love, but it’ll quickly be torn to shreds, make the party look foolish, and make clear that the GOP is not to be trusted with health care policy. Indeed, it would very likely scare the American mainstream to be reminded what Republicans would do if the power over the system were in their hands.
On other hand, Republicans could present a half-way credible policy, but it would have to require some regulations and public investments, which necessarily means the party’s base would find it abhorrent.
As a Republican Hill staffer recently told Sahil Kapur, every attempt to come up with a serious proposal leads to a plan that “looks a hell of a lot like the Affordable Care Act.” And so we get … nothing.
Nothing, that is, except the Democratic law, which is working quite well, Republican assurances to the contrary and repeated attempts at sabotage notwithstanding.
By: Steve Benen, The Maddow Blog, May 30, 2014
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